A Rare Case of Mad Honey Disease: A Reversible Cause of Complete Heart Block.

This case describes a patient with hypotension, bradycardia, and third-degree atrioventricular block following ingestion of a grayanotoxin-containing Pieris species, or lily of the valley bush. Although unlikely in metropolitan environments, physicians should be aware of the possibility of grayanotoxin ingestion when confronted with new-onset heart block even in nonendemic areas. (Level of Difficulty: Beginner.).

Evaluation of 30 Day Readmissions After Index Ventricular Assist Device Implantation in the United States.

Ventricular assist device (VAD) implantation has improved quality of life and short-term survival for advanced heart failure patients. There are limited data from single-center studies addressing the characteristics and etiologies of 30 day readmissions after VAD implant. We used the Nationwide Readmissions Database (NRD) 2014 to identify insertion of implantable heart assist system during index admission. Primary and secondary outcomes were 30 day readmissions and leading etiologies, respectively. We analyzed 1,481 patients who received VAD during the primary admission of whom 1,315 patients survived to hospital discharge (mortality rate 11.2%), and 60.6% were discharged to a nursing facility. One hundred and thirty-one (10.0%) patients were readmitted within 30 days of primary hospitalization. Leading etiologies of 30 day readmission were bleeding (24%), heart failure (18%), and device complications (14%). Mean length of stay during readmission was 13.8 days with a mortality rate of 2.1%. Fifty percent of 30 day readmissions were readmitted from day 22 to 30. Variables for predictors of 30 day readmissions were not statistically significant. By identifying gastrointestinal bleeding, heart failure, and device complications as leading etiologies of 30 day readmission post-VAD implantation, providers can potentially modify practices to prevent hospital readmissions, decreasing cost of care, and improving the quality of life of patients.

Accuracy and Efficacy of Hand-Held Echocardiography in Diagnosing Valve Disease: A Systematic Review.

In recent years, advances in technology have enabled hand-held echocardiography (HHE) to generate high-quality 2-dimensional and color Doppler images. As these devices become smaller, simpler, and more affordable, the question of whether HHE can augment or replace auscultation as the primary mode of cardiovascular diagnosis has become increasingly more relevant. If widely implemented, HHE has the potential for significant cost savings and better resource utilization. This review examines studies comparing the sensitivities of auscultation, HHE, and standard echocardiography in detecting various valvular lesions and discusses why current evidence supports the use of HHE to augment the physical examination, which can lead to more reliable and rapid bedside diagnoses, triage, and appropriate treatment of structural cardiac abnormalities.

Etiologies, Trends, and Predictors of 30-Day Readmissions in Patients With Diastolic Heart Failure.

An estimated half of all heart failure (HF) populations has been categorized to have diastolic HF (DHF), but sparse data are available describing etiologies and predictors of 30-day readmission in DHF population. The study cohort was derived from the National Readmission Database 2013 to 2014, a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. DHF was identified using International Classification of Diseases, 9th Revision code 428.3x in primary diagnosis field. Readmission etiologies were identified by International Classification of Diseases, 9th Revision code in primary diagnosis field. The primary outcome was 30-day readmission. Hierarchical multivariable logistic regression was used to adjust for confounders. In total, 192,394 patients with DHF were included, of which 40,927 (21.27%) patients were readmitted with total readmissions of 47,056 within 30 days. Predictors of increased readmissions were age (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.001 to 1.0003, p <0.001), diabetes (OR 1.08, 95% CI 1.05 to 1.11, p <0.001), chronic pulmonary disease (OR 1.18, 95% CI 1.15 to 1.21, p <0.001), renal failure (OR 1.21, 95% CI 1.17 to 1.25, p <0.001), peripheral vascular disease (OR 1.05, 95% CI 1.02 to 1.09, p = 0.002), anemia (OR 1.12, 95% CI 1.10 to 1.15, p <0.001), transfusion during index admission (OR 1.18, 95% CI 1.13 to 1.23, p <0.001), discharge to the facility (OR 1.13, 95% CI 1.10 to 1.16, p <0.001), length of stay >2 days, and Charlson comorbidity index ≥3, whereas obesity (OR 0.82, 95% CI 0.80 to 0.85, p <0.001), elective admissions (OR 0.88, 95% CI 0.83 to 0.94, p <0.001), and non-Medicare/Medicaid primary payer were predictors of lower readmission rate. Most common etiologies of readmission were acute HF (28.01%), infections (9.54%), acute kidney injury (5.35%), acute respiratory failure (4.86%), and pneumonia (3.92%). In conclusion, DHF population with higher comorbidity burden, longer length of stay, and discharge to facility were prone to increased readmissions, with most common etiologies of readmission being HF, infections, and acute kidney injury.

Prevalence of hypertension in the Gambia and Sierra Leone, western Africa: a cross-sectional study.

BACKGROUND: Hypertension (HTN) is one of the causes of cardiovascular disease (CVD) in Africa, and may be associated with lower socio-economic status (SES). The prevalence of HTN is not well established in the Gambia or in Sierra Leone. METHODS: A cross-sectional, population-based study of adults was conducted in the Gambia in 2000 and in Sierra Leone from 2001 to 2003 and in 2009. The study was conducted as part of the annual visit to countries in western Africa sponsored by a medical delegation from California. People from the Gambia and Sierra Leone were examined by the medical delegation and blood pressures were measured. RESULTS: A total of 2 615 adults were examined: 1 400 females and 1 215 males. The mean systolic blood pressure (SBP) of the females was 134.3 ± 29.7 mmHg, mean diastolic blood pressure (DBP) was 84.5 ± 17.5 mmHg, and 46.2% were hypertensive. The mean SBP of the males was 132.8 ± 28.5 mmHg, mean DBP was 82.8 ± 16.2 mmHg, and 43.2% were hypertensive. Overall prevalence of HTN in the subjects was 44.8%. Mean SBP, mean DBP and HTN prevalence increased with age decade, both in males and females. In addition, after age adjustment (known age), females had higher mean SBP (p = 0.042), mean DBP (p = 0.001) and rate of occurrence of HTN (p = 0.016) when compared with males. CONCLUSIONS: Prevalence rates of HTN in the Gambia and Sierra Leone were higher than 40% in males and females, and may be a major contributor to CVD in both countries. Due to the association of HTN with low SES, improvements in educational, public health, economic, non-governmental and governmental efforts in the Gambia and Sierra Leone may lead to a lower prevalence of HTN. The cause of the higher prevalence in women may be due to post-menopausal hormonal changes.

Sexual function in patients supported with left ventricular assist device and with heart transplant.

AIMS: Sexual dysfunction is common among patients with heart failure (HF) and considered an important hamper to quality of life. While implantation of left ventricular assist device (LVAD) may prolong and improve life in advanced HF, limited data are available on its impact on sexual function. The aim of this study is to evaluate sexual function in LVAD patients and compare this with patients after heart transplantation (HTx). METHODS AND RESULTS: Sexual activity and satisfaction of stable patients with durable LVAD or after HTx were evaluated using a validated questionnaire and visual analogue scale from 0 to 10. Data were collected from 31 patients (mean age 59 ± 12 years, 87% male), 17 after HTx and 14 with LVAD. Pleasure or satisfaction with sex was significantly higher in HTx patients (P = 0.0005). In total, 29% LVAD patients and 71% HTx patients reported content with sexual activity. Recalled satisfaction with sex life pre-operation was comparable between the groups. During support, satisfaction with sex life using visual analogue scale was 7.6 ± 3.1 for HTx versus 3.9 ± 4.0 for LVAD patients (P = 0.017). In total, 11 LVAD patients (79%) reported specific problems in sexual function including erectile dysfunction or vaginal dryness (8, 57%); problems with the LVAD, cable, or batteries (5, 36%); problems with orgasm (4,29%); and other problems such as fear of injury, feeling depressed, partner issues, self-image, and pain (1, 7% each). CONCLUSION: Sexual dysfunction occurs in patients with LVAD support and may be more prominent than after HTx. Problems limiting sexual function related to physiological, psychological, and equipment merit consideration during follow-up.